- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $35.67 / $101.46
| Facility | | $4.76 | $35.67 | $101.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $5.28 / $5.28
| Professional | | $3.75 | $5.28 | $5.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.94 / $2.94 / $2.94
| Facility | | $2.94 | $2.94 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $5.37 / $8.34
| Professional | | $3.20 | $5.37 | $8.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.11 / $12.02 / $70.52
| Facility | | $11.11 | $12.02 | $70.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.90 / $2.71 / $6.31
| Professional | | $1.90 | $2.71 | $6.31 |